One Team, One Goal: The Key to Better Patient Outcomes in Early Breast Cancer Management Authors: Fatima Cardoso, MD, FESMO, ESCO; Nadia Harbeck, MD, PhD; Shani Paluch, MBBS, MSc

https://www.medscape.org/viewarticle/1002593?sso=true&uac=148436CN&src=mkmcmr_reeng_recap_mscpedu_activity One Team, One Goal: The Key to Better Patient Outcomes in Early Breast Cancer Management Below are some key learning points to help reinforce the impact of this activity. ☑ HR+/HER2- breast cancer • For a 28-year old woman with cT2 cN1 cM0, HR+/HER2-negative breast cancer with germline BRCA wild-type, therapy recommendations would be pre-operative endocrine therapy, based on data from the ADAPT trial • In this patient, considering that she was ypT2 ypN1 after neoadjuvant therapy and surgery, adjuvant therapy with either exemestane or tamoxifen, ovarian function suppression plus an aromatase inhibitor is warranted • These recommendations are supported by long-term data from the SOFT and TEXT trials, as well as monarchE and NATALEE • The ADAPTcycle trial which is ongoing will also serve to inform if chemotherapy can be substituted for endocrine therapy based on recurrence risk scores and response to endocrine therapy ☑ HER2-positive early breast cancer • For a 55-year-old patient with Grade 3, ER 80%, PR 30%, HER2 IHC3+, Ki-67 60% cT2 (2.5 cm) cN0 disease, ESMO currently recommends neoadjuvant therapy with trastuzumab + pertuzumab + chemotherapy • This recommendation is supported by long-term (11.3 years) follow-up data from APHINITY, which showed sustained improvement with this regimen vs trastuzumab + chemotherapy • If after surgery, the patient still has residual disease, the patient should continue to receive adjuvant T-DM1 (KATHERINE data), with the potential for also receiving neratinib (ExteNET data) • Current ongoing trials which could inform treatment decisions in the future include DESTINY-Breast05 (adjuvant T-DXd compared to T-DM1) and DESTINY-Breast11 (neoadjuvant T-DXd vs standard of care) ☑ Triple-negative early breast cancer • For a patient with Grade 3, ER-/PR-/HER2-negative, Ki-67 80%, with germline BRCA mutation, ESMO currently recommends neoadjuvant therapy with chemotherapy + pembrolizumab, followed by surgery, and if non-PCR, adjuvant pembrolizumab or olaparib • These recommendations are based on ◦ KEYNOTE-522 (phase 3), which showed significantly improved outcomes with pembrolizumab vs placebo, on a backbone of chemotherapy ◦ OlympiA (phase 3), which showed significantly improved outcomes with olaparib vs placebo • Multiple clinical trials with various antibody-drug conjugates are ongoing in this setting